It is known that patients with active IBD have an increased risk of preterm birth, slowed fetal growth, low birth weight, hypertensive disease of pregnancy, and cesarean birth. On the other hand, conception during disease remission results in similar relapse rates as for people with IBD who are not pregnant.

Inflammatory bowel disease (IBD), including Chron’s disease and ulcerative colitis, is commonly diagnosed between the ages of 15 and 30 years, with about half of patients receiving a diagnosis before the age of 30. Because many people living with IBD are of reproductive age, effective management of the disease during pregnancy is essential.

Leveraging results from published research and expert opinion, the American Gastroenterological Association (AGA) recently published a clinical practice update for the management of gastrointestinal (GI) and liver disease in pregnant patients. The full update can be found in the October 2024 issue of Gastroenterology.

Lead author Shivangi Kothari, M.D., from the division of gastroenterology and hepatology at the University of Rochester, New York, and her colleagues compiled 13 Best Practice Advice statements meant to provide practical advice for clinicians.

The team emphasizes the importance of preconception counseling by a multidisciplinary team for people of reproductive age who wish to become pregnant. They advise against withholding medications, procedures, or other interventions solely due to pregnancy. Instead, the patient’s care should be individualized after assessing the benefits and potential risks associated with the treatment or procedure.

Given these findings, the AGA panel advises that patients with IBD should be in clinical remission before conception, during pregnancy, and during the postpartum period. The team recommends continuing biologic treatments, such as tumor necrosis factor (TNF) inhibitors, throughout pregnancy and postpartum. However, they recommend against administering live vaccines during the first six months of life to infants exposed to TNF inhibitors after 20 weeks of gestation.

IBD flares should be managed similarly for pregnant and nonpregnant people. Mesalamine, 6-mercaptopurine, and azathioprine are considered safe to use during pregnancy. Other agents, such as methotrexate, thalidomide, and Zeposia (ozanimod) are contraindicated during pregnancy.

Regarding endoscopies, the authors advise deferring elective procedures until after delivery. Nonurgent necessary procedures should be done during the second trimester.

Kothari and her colleagues aim to provide guidance for multidisciplinary teams managing GI and liver disease in pregnant people. “A paramount goal is to keep both the patient and the fetus safe,” they wrote.